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Cold Caps May Prevent Chemotherapy Hair Loss

When you're facing the prospect of hair loss due to chemotherapy treatments for breast cancer, you may simply need to keep a cool head — actually, an ice-cold one. Using cold caps may help you keep your hair through chemotherapy.

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Can it be true that all you need to prevent hair loss during chemotherapy is to wear a series of cold caps frozen to -30 degrees Celsius (-22 degrees Fahrenheit) during treatment? For breast cancer patients, preserving a full head of hair can boost morale and create a feeling of resilience, even if it takes a dry-ice-cooled head to achieve that goal.

Cold caps were tried unsuccessfully 10 years ago. However, they are making a comeback with greater success at controlling hair loss, according to cold cap advocates.

“The exact mechanism has not been worked out,” explains Tessa Cigler, MD, an oncologist at the Weill Cornell Breast Center in New York City “There are several hypotheses, the most compelling of which is that the cold caps cause vasoconstriction of the blood vessels closest to them.” That means that the cold caps, when they are used correctly, are at just the right temperature to prevent chemotherapy medications from entering the blood around the hair follicles.

The Weill Cornell Breast Center is the recipient of one of the biomedical freezers donated by the Rapunzel Project, a non-profit dedicated to spreading the word about cold caps and to raising the money to provide these specialized freezers to chemotherapy treatment rooms so that cancer patients have one more option to preserve their hair.

Dr. Cigler emphasizes that if cancer patients want to undertake the cold cap procedure, they should be able to do so. Further, she says, this option might tip the balance for many breast cancer patients who are trying to decide whether to undergo chemotherapy.

“We are open to supporting our patients if they strongly desire the cold caps,” says Cigler. “For many people, losing hair is a deterrent to doing the prevention chemotherapy. If it’s a choice between cold caps and not doing the chemo, do the cold caps.”

Cold Caps for Hair Loss 101

“I had already purchased my wig,” recalls Shirley Billigmeier, one of the founders of the Rapunzel Project. A chance conversation about the possibility of preserving her eyebrows by chilling them led her to investigate cold caps. Soon she was in touch with Medical Specialties of California, distributor of Penguin Cold Caps in the United States.

“When I started talking about this, people kept saying there is no way to save your hair, just accept it,” recalls the 60-year-old breast cancer survivor. She was undergoing chemotherapy and didn’t want to tell anyone about her breast cancer. Her oncologist was only reluctantly supportive, telling her later — when she came through chemo without any hair loss — that he had not believed the cold caps would work.

The primary problem is that cold caps have to be kept much colder than the average freezer can make them. This meant that breast cancer patients, their friends, and families had to go through an awkward dance involving thermometers and timers to chill the caps using dry ice and then get them on the patient’s head fast enough for them to be effective. Billigmeier and her friends raised the money to buy a biomedical freezer for the cancer center where she received treatment, and then decided to continue the fundraising on a national level.

Cold Caps for Chemotherapy Hair Loss: Costs, Risks and Benefits

One fact there is no way around is that a cold cap at first feels unbearably cold. But patients say this is a cold they are willing to endure if they can keep their hair.

“It’s not any worse than having a baby,” recalls breast cancer survivor Geralyn Pewarchie, a resident of Michigan. “It’s cold for the first two minutes you put the cap on — I was ready to pull it off the first time. It almost seems like you can’t take it.”

The caps are changed out every 30 minutes in order to keep the hair chilled to the right temperature. “You get a little chilled during chemo because normally chemotherapy rooms are cold anyway and chemotherapy is cold liquid running through your veins,” says Perwachie. Dress warmly and bring a blanket, she advises.

Like Billigmeier, Pewarchie, 51, was undergoing chemotherapy as a preventive measure and she, too, did not want to look like she was ill. She recalls thinking at the time, “I’m not dying, I’m not sick, but I’m going to get this treatment as an insurance policy and I’m going to look like I’m dying for the next year.” She did her research and decided on the cold caps. When she still had her hair during and after treatment, Pewarchie knew she had made the right choice. She says that actually using the caps is merely a matter of planning and repetition. “The most stressful [part] is getting them ordered and on time for your chemo. You have to get the forms, get credit in, and until you know those caps are in the house, you’re a nervous wreck.”

Costs, Benefits, and Safety

The cost of cold caps is comparable to (and perhaps slightly less than) the cost of a good wig. Billigmeier estimates that breast cancer patients are looking at about $30 per cap per month. Her total cost was $1,400. Your costs will vary based on how much chemotherapy treatment you require. Some health insurance plans will cover the cost of a wig and, say cold cap advocates, women have been successful in getting the cost of cold caps covered instead.

Ultimately, cold caps may be worth the effort (and the chill), especially as they seem to provide positive benefits as they boost women’s spirits. “We’re always looking for ways to improve the quality of life during chemotherapy, which can be such a difficult time for women, and cold caps look like they might be a promising option,” says Cigler.

Regarding safety, some doctors have a theoretical concern that cancer cells have metastasized to the scalp may be able to “hide” from the chemotherapy if you use cold caps. Long-term studies are needed to determine whether this actually occurs and if cold caps are safe for all breast cancer patients.

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